229835 Using quantitative risk information in primary care

Tuesday, November 9, 2010 : 5:30 PM - 5:50 PM

J.B. Jones, PhD, MBA , Henry Hood Center for Health Research, Geisinger Health System, Danville, PA
Background:Disease-specific quantitative risk (QR) formulas have been developed and validated for multiple conditions and have the potential for diverse uses in healthcare. Few, however, are routinely used in care settings, largely because of workflow challenges in obtaining data, processing the formula and using the results in real time. Purpose/objectives: We describe HIT-enabled uses of the Framingham Risk Score (FRS) for heart attack in primary care clinics with electronic health records (EHR). Methods:We translated the FRS into a format suitable for routine use in an EHR-based practice setting. Relative risk is used to stratify patients. Those at elevated risk are presented with a dynamic graphical display of a their short-term cardiovascular risk and are able to: 1) see how changes in modifiable risk factors translate into lower risk, 2) set personal goals for change, and 3) discuss these goals with a clinician to create a prioritized treatment plan. Results:Using age and gender screening criteria, we identified a cohort of 6,720 potentially at-risk patients. Data necessary to calculate risk were obtained from patients completing a touchscreen-based risk assessment questionnaire during a clinic visit; 1,438 patients completed the questionnaire and QRI (i.e., an absolute FRS value) could be calculated for 38% (538). In this QRI cohort, 37% (199) had moderate-high relative risk and at least one modifiable risk factor. QRI was then used to tailor a HIT-based tool which allowed patients to set goals, select treatment options and view the impact on their FRS. Physicians received treatment preferences/goals via the EHR. Discussion:Behavior change is likely to occur when patients understand the severity of their modifiable risks in the context of available treatment options. Using HIT, we automated the process of calculating QRI and displaying it to patients in an intuitive format that prompts patients to discuss their risk-lowering treatment preferences with their physician.

Learning Areas:
Chronic disease management and prevention
Communication and informatics

Learning Objectives:
By the end of the session the participant will be able to: 1)Describe why available risk calculators are not used in practice 2)Identify both the benefits and challenges associated with using QRI in a primary care practice setting 3)Describe the results of a pilot project that integrates QRI into routine care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I oversee the HIT projects at the Geisinger Center for Health Research
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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